Authorization To Deduct Paycheck

Deducting Paycheck Authorization Form

Employee Name: ________________________________

EID Number: ________________________________

Address: ________________________________

City, State, Zip: ________________________________

I, the undersigned, hereby authorize ___________________________ to deduct the following amounts from my salary before depositing my paycheck into my account:

Total Due: ________________________

Amt. Deducted per Cycle: ________________________

Deduction Type: ______________________

I understand that, should I be terminated from this position, regardless of the reason, the full amount due will be deducted from my last paycheck, up to and including the full paycheck, and that I will be liable for any remainder. I further understand that all deductions will take place after mandatory state and federal taxes are applied.

Signature _________________________ Date __________

Witness    _________________________ Date __________

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